A red AIDS banner hangs on the wall, adjacent to a colorful gay pride flag, and surrounded by posters promoting HIV prevention. Gilberto Colon sits at his desk, helping a tearful Latina woman fill out a medical form, as a teenage boy peruses a brochure on sexually transmitted diseases.

It’s a typical morning at Alianza Dominicana, a community-based organization in Washington Heights that offers counseling and prevention education to people living with HIV and AIDS.

Nurse practitioner John Nelson works with HIV-infected teens at Project STAY, or Services to Assist Youth, in Harlem. Photo: Yaffi Spodek

Colon, 53, first discovered the haven on Amsterdam Avenue and West 176th Street while attending support groups for people infected with HIV. For the last decade, he has worked as a peer educator, administering free HIV tests and teaching about the dangers of unprotected sex. Each month, about 60 people are tested, while an outreach team travels to parks and street corners, handing out hundreds of safe sex kits each week.

“I wanted to help these kids because nobody was there to educate me when I was their age,” Colon said.

Colon learned that he was HIV positive years ago, but his healthy appearance belies his condition. Thanks to medication, he is able to enjoy a normal life. But others aren’t so lucky.

HIV, or human immunodeficiency virus, is a debilitating disease that infects people of all ages and backgrounds, and members of the Latino population in particular.

Hispanics comprised 15 percent of the U.S. population in 2006, but accounted for 18 percent of the 37,331 AIDS/HIV diagnoses, according to the federal Centers for Disease Control and Prevention.

A 2007 report by the city Department of Health and Mental Hygiene stated that 1,669 people, or about 46 percent, of the 3,621 residents in Washington Heights and Inwood who were living with AIDS and HIV were Hispanic. Hispanics also accounted for 89 of the 174 new cases of HIV diagnosed in that community, slightly more than half the total.

While sexual education and testing have been promoted in the Latino community in recent years, the number of people being diagnosed with HIV is increasing. As outreach efforts continue, health experts are expressing frustration regarding the discouraging statistics and the spread of the epidemic.

At New York-Presbyterian Hospital, more than 3,000 people –– about 60 percent of whom are Latino –– are tested annually by the Counseling and Testing Services Program, according to Paula Merricks-Lewis, the manager of the rapid testing program. About 25 people a year are identified as HIV positive, a figure that has remained consistent for 2006, 2007 and 2008. This year, however, the program already had 35 patients who tested positive.

“I suspect that might mean that more people who have been infected for years without realizing it are finally getting tested because of publicity about the availability of the rapid test and the fact that it is free,” said Dr. Karen Brudney, the director of the Infectious Diseases Clinic at New York-Presbyterian, emphasizing that she is a clinician and not an epidemiologist. She added that the city Department of Health has “made a major effort to ‘normalize’ HIV testing.”

However, resistance to testing is prevalent among Latina women, who harbor the misconception that age is a barrier to contracting HIV. Others, who may feel secure in monogamous relationships, are often infected by unfaithful spouses, observed Merricks-Lewis.

“You encounter women, in their 50s, 60s and 70s, who feel that they are not at risk and so they don’t get tested,” she said. “What’s been happening is that people are getting diagnosed later, and we are finding people who are not HIV positive anymore, but who have AIDS.”

A 2008 study in the International Journal of Aging and Human Development explored the knowledge of adult Latinos with HIV/AIDS. It found that approximately two-thirds of the population ascribed to at least one myth regarding viral transmission of the disease, for example via mosquito bites or using public toilets. Less than half were aware of age and gender specific risk factors.

Resistance also stems from stigma associated with the virus. Though HIV is no longer viewed as a terminal illness, women who test positive are stereotypically labeled as promiscuous, and men as homosexuals or bisexual drug users. Adolescents, who usually contract HIV through sex, are typically asymptomatic and can remain that way for years without the disease manifesting itself.

Jenny Perez, 18, knows firsthand about the resistance, which she says is borne primarily from ignorance. Since she was 16, Perez has worked at Alianza Dominicana, first as a volunteer educator and now as a member of its outreach team.

“Some kids just don’t know what’s out there, and they’re embarrassed to even take a condom from us,” she said. “Others know about HIV, but don’t realize that they can be tested right in the neighborhood.”

Anna Potter of Project STAY travels to schools and administers free HIV tests like OraQuick, a rapid oral test. Photo: Yaffi Spodek

Health experts highlighted a deeper problem. “There is a fear of being rejected, victimized, and emotionally and physically abused,” observed John Nelson, a nurse practitioner with Project STAY, or Services to Assist Youth, a Harlem-based organization providing counseling, testing and treatment to adolescents. “As long as they feel OK, they don’t feel the need to get tested.”

At the same time, people will knowingly engage in unprotected sex with partners who are HIV positive. In communities such as Washington Heights, Nelson noted, Latino adolescents suffer from low self-esteem due to racism, and view sex as a way to be more social. Many don’t envision their lives past age 30, believing that contracting HIV is insignificant, and can even be beneficial in terms of qualifying for government housing provided to poor people who develop AIDS.

“People don’t view it as a death sentence, especially when they have been living with it their whole lives,” Nelson explained.

Project STAY’s client intake has doubled since 2006, seeing a 5 to 10 percent increase each year. The organization now treats close to 70 people, about half of whom are Latinos from Washington Heights and the Bronx.

But while the number of cases rises, funding has remained the same, and Nelson says the staff and resources are feeling the crunch. Reflecting on more than a decade of experience working with youth infected with HIV, he believes that education, especially during the earlier formative years, is crucial.

“Abstinence is not the best policy because it’s not realistic,” Nelson said. “Our message needs to be directed to adolescents, teaching them self-esteem and to value their bodies.”

Others have different theories. Oscar Raul López, director of health policy for the New York-based Latino Commission on AIDS, maintains that part of the problem lies within the U.S. health care system. He says it is not culturally competent or able to address language barriers, particularly when dealing with an immigrant population.

“Latinos, many who are undocumented immigrants, are afraid of the system, and would rather wait until they’re deathly ill to see a doctor,” he said.

Two groups have experienced the largest increases in HIV diagnoses. Nationally, men who have sex with men account for only 4 percent of the population, but 53 percent of all HIV cases. A second group is young Latina women, who are often on the defensive in abusive relationships, says López.

“If their spouse or partner has HIV, women can’t advocate to protect themselves,” he said. “Women in general, and especially Latinos, tend to put children and spouses first, before their health.”

Joanna Pudil, a social worker for Project STAY, elaborated on this theme. “I can’t say for sure why the numbers are going up, but studies have looked at power within relationships,” she said. “Latino male partners have control over whether to use birth control or condoms. These women are afraid to stand up to them, usually older partners whose sexual history may not be known.”

Another factor in the rise of HIV cases can be attributed to a lack of sexual education.

“The Latino culture in general does not allow for open conversations about sex and drug use,” López said. “These are taboo topics. The kids hear about it, but don’t know how it’s spread… The numbers are worrisome.”

In response to the disproportionate statistics, López says the commission has shifted some of its outreach from education to encouraging people to get tested and be aware of their status, hoping to further reduce the spread of the disease, and hasten diagnosis and treatment for those who are positive.

According to López, Latinos usually get their AIDS diagnoses in hospital emergency rooms. “They are shaving almost 20 years off their life because they didn’t know they had it, or because they waited too long to start treatment,” he said.

On Dec. 4, the federal Office of National AIDS Policy hosted a community forum at the Alumni Auditorium of Columbia University Medical Center in Washington Heights, to help shape its national policy, which focuses on reducing new infections, increasing the number of people in care, and lowering HIV-related health disparities. The Latino Commission on AIDS chartered a bus to transport 50 clients to the meeting, where each person testified for a minute and a half, sharing their history of the disease.

“The Latino community needs to speak up to secure the proper funding and resources to address this issue,” López said, emphasizing that although progress has been made, there is more that needs to be done.

Nelson agreed. “It is frustrating,” he acknowledged. “We have come a little ways, but still have a ways to go.”